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Vermont - Integrated Employment — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Vermont, Integrated Employment (also known as Supported Employment) is delivered under the state's Global Commitment to Health Section 1115 demonstration waiver and managed by the Department of Disabilities, Aging, and Independent Living (DAIL). The service provides job development, placement, and on-site coaching to help individuals achieve competitive work in a community setting at prevailing wages.

To become a provider, an agency must first secure designation and program approval from the Adult Services Division (ASD) before applying for Medicaid enrollment. This gatekeeping step ensures that only providers meeting DAIL's specific certification standards and network needs are permitted to bill the Vermont Medicaid program for these services.

1. Service Definition and Scope

Integrated Employment, often referred to as Supported Employment in Vermont, focuses on assisting individuals with disabilities to obtain and maintain competitive employment in integrated community settings. The service is designed to lead to employment at or above the minimum wage, matching the prevailing wage for similar work.

The scope includes job development, job placement, and ongoing on-site coaching. It does not include facility-based or sheltered workshop employment, as the emphasis is strictly on community integration and competitive wages.

2. Regulatory and Oversight Agencies

The primary oversight body for this service is the Department of Disabilities, Aging, and Independent Living (DAIL), specifically through its Adult Services Division (ASD). DAIL is responsible for provider certification, program approval, and ongoing quality management.

Medicaid enrollment and claims processing are managed by the Department of Vermont Health Access (DVHA) and its fiscal agent, Gainwell Technologies, through the Provider Management Module.

3. Gatekeeping Prerequisites: Who Can Even Apply

Vermont employs a strict gatekeeping process for HCBS providers. Before an agency can enroll with Medicaid to provide Integrated Employment, it must first obtain approval from the Adult Services Division (ASD).

This means that standalone Medicaid enrollment applications submitted without prior DAIL/ASD approval will not be processed. Providers must follow the specific "Provider Enrollment Process Summary" issued by ASD.

4. Licensure and Certification Requirements

Vermont does not issue a traditional "facility license" for Integrated Employment providers. Instead, agencies must meet DAIL's Agency Certification Standards to operate as a designated provider.

The certification process involves a review of the agency's policies, procedures, and capacity to deliver employment services in compliance with HCBS Settings Rules and state guidelines.

5. Medicaid Provider Enrollment

Once approved by DAIL, the provider is instructed to submit a Medicaid Provider Enrollment application. This is done entirely online through the Vermont Medicaid Provider Management Module.

Providers must submit their legal name, Federal Tax Identification Number (TIN), and National Provider Identifier (NPI), along with a signed General Provider Agreement.

6. Staffing, Training and Background Checks

Staff providing Integrated Employment services must meet specific qualifications and undergo background checks as mandated by DAIL and Vermont Medicaid. Training focuses on job coaching techniques, rights and dignity, and incident reporting.

Agencies are responsible for maintaining documentation of all staff training and background check clearances in their personnel files for audit purposes.

7. Documentation, Policies and Records

Providers must maintain comprehensive records demonstrating that services were delivered as billed and that they meet the definition of Integrated Employment. This includes documenting the individual's progress toward competitive employment.

Customized policy manuals must align with DAIL's Agency Certification Standards and Vermont Medicaid's General Provider Manual requirements.

8. Billing, Rates and Claims

Billing for Integrated Employment is processed through the Vermont Medicaid portal using specific procedure codes and modifiers outlined in the DVHA Fee Schedule. The fee schedule is updated monthly.

Providers must ensure claims are submitted within timely filing limits and must accept the Medicaid payment as payment in full, with no balance billing to the member.

9. Approval Sequence and Timeline

The approval process is strictly sequential. An agency must first review the "Provider Enrollment Process Summary," submit the required application to ASD, and await DAIL approval.

Only after receiving written approval from DAIL can the agency proceed to the Provider Management Module to complete the Medicaid enrollment. The entire process can take several months depending on application completeness and state review times.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied if a provider attempts to enroll in Medicaid without first securing DAIL/ASD approval. Incomplete applications or failure to meet the HCBS Settings Rule for community integration are also common issues.

During surveys, auditors often cite providers for inadequate documentation of staff training, missing background checks, or failure to prove that employment settings are truly integrated and paying prevailing wages.

11. Key Contacts and Resources

Prospective providers should utilize the official state resources for the most current forms, manuals, and fee schedules. The Adult Services Division and Vermont Medicaid portals are the primary hubs for information.

For specific questions regarding the initial application, providers should contact the ASD Provider Enrollment email directly.

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